Doctor Name: | DR. EDWARD MARVIN GOTLIEB |
NPI Number: | 1093713356 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 014500 |
Business Practice Address: | 5405 Memorial Dr Building D Stone Mountain, GA - 300833234 |
Business Phone Number: | 4042963800 |
Business Fax Number: | 4042978753 |
Mailing Address: | 5405 Memorial Dr, Building D STONE MOUNTAIN |
State: | GA |
Postal Code: | 300833234 |
Phone Number: | 4042963800 |
Fax Number: | 4042978753 |
NPI Enumeration Date: | 07/11/2005 |
NPI Last Update Date: | 09/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2080A0000X |
License Number: | 014500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Pediatrics |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |